TY - JOUR
T1 - Overall survival comparison between androgen deprivation therapy (ADT) plus external beam radiation therapy (EBRT) vs ADT plus EBRT with brachytherapy boost in clinically node-positive prostate cancer
AU - Fischer-Valuck, Benjamin W.
AU - Rao, Yuan James
AU - Brenneman, Randall J.
AU - Patel, Pretesh R.
AU - Filson, Christopher P.
AU - Jani, Ashesh B.
AU - Liu, Yuan
AU - Goyal, Subir
AU - Xu, Karen
AU - Weiss, Aaron
AU - Kucuk, Omer
AU - Cimmino, Cara
AU - Szabo, Stephen
AU - Rossi, Peter
AU - Baumann, Brian C.
AU - Pattaras, John
AU - Hershatter, Bruce
AU - Patel, Sagar A.
N1 - Publisher Copyright:
© 2020 American Brachytherapy Society
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Purpose: Optimal therapy for clinically node-positive, nonmetastatic (cN1) prostate cancer (PC) patients remains controversial, ranging from aggressive local therapy to palliative systematic therapy alone. Despite guideline support, it is unclear if a brachytherapy (BT) boost should be considered for cN1 patients as these patients were excluded from randomized trials establishing its benefit. Herein, we compare definitive radiation therapy (RT) with or without a BT boost in cN1 PC. Methods and materials: The National Cancer Database was used to identify men with cN1 PC treated with definitive RT and concomitant androgen deprivation therapy between 2004 and 2013. Overall survival (OS) was compared between those who received external beam RT (EBRT) or combination EBRT plus BT boost (EBRT + BT) using Kaplan–Meier with propensity score matching and Cox proportional hazards. Results: With a median followup of 48.5 months, 1,650 patients were eligible for this analysis, 103 (6.2%) of whom received EBRT + BT. Younger age, no medical comorbidities, and Gleason score of six were associated with higher likelihood of receiving EBRT + BT over EBRT alone. The mean (median) OS for EBRT and EBRT + BT was 99.0 (110.6) months vs 109.2 (not reached) months, respectively (p = 0.048). However, no significance difference in OS was observed between the groups after propensity score matching. On multivariable analysis, EBRT + BT was not significantly associated with improved OS (adjusted HR 0.67, 95% CI, 0.41–1.07, p = 0.098). Conclusions: In this retrospective, observational study of patients with cN1 PC treated with definitive RT and concomitant androgen deprivation therapy, EBRT + BT had an unadjusted improvement in OS compared with EBRT alone that lost statistical significance after multivariable adjustment and propensity score matching.
AB - Purpose: Optimal therapy for clinically node-positive, nonmetastatic (cN1) prostate cancer (PC) patients remains controversial, ranging from aggressive local therapy to palliative systematic therapy alone. Despite guideline support, it is unclear if a brachytherapy (BT) boost should be considered for cN1 patients as these patients were excluded from randomized trials establishing its benefit. Herein, we compare definitive radiation therapy (RT) with or without a BT boost in cN1 PC. Methods and materials: The National Cancer Database was used to identify men with cN1 PC treated with definitive RT and concomitant androgen deprivation therapy between 2004 and 2013. Overall survival (OS) was compared between those who received external beam RT (EBRT) or combination EBRT plus BT boost (EBRT + BT) using Kaplan–Meier with propensity score matching and Cox proportional hazards. Results: With a median followup of 48.5 months, 1,650 patients were eligible for this analysis, 103 (6.2%) of whom received EBRT + BT. Younger age, no medical comorbidities, and Gleason score of six were associated with higher likelihood of receiving EBRT + BT over EBRT alone. The mean (median) OS for EBRT and EBRT + BT was 99.0 (110.6) months vs 109.2 (not reached) months, respectively (p = 0.048). However, no significance difference in OS was observed between the groups after propensity score matching. On multivariable analysis, EBRT + BT was not significantly associated with improved OS (adjusted HR 0.67, 95% CI, 0.41–1.07, p = 0.098). Conclusions: In this retrospective, observational study of patients with cN1 PC treated with definitive RT and concomitant androgen deprivation therapy, EBRT + BT had an unadjusted improvement in OS compared with EBRT alone that lost statistical significance after multivariable adjustment and propensity score matching.
KW - Brachytherapy
KW - EBRT plus brachytherapy
KW - NCDB
KW - Node positive prostate cancer
UR - http://www.scopus.com/inward/record.url?scp=85087361849&partnerID=8YFLogxK
U2 - 10.1016/j.brachy.2020.05.007
DO - 10.1016/j.brachy.2020.05.007
M3 - Article
C2 - 32624405
AN - SCOPUS:85087361849
SN - 1538-4721
VL - 19
SP - 557
EP - 566
JO - Brachytherapy
JF - Brachytherapy
IS - 5
ER -